Ask the doctor: My husband always needs to go to the loo

Dr Martin Scurr has been treating patients for more
than 30 years and is one of the country's leading GPs. Here he answers your questions…

My husband, who is 75, has for some months suffered a frequent and urgent need to visit the loo — sometimes several times in one hour. He has twice had antibiotics for a bladder infection (he also has type 2 diabetes), but this problem continues to cause him embarrassment.

Dorothy Stevens, Loughton, Essex.

The problem that is giving your husband such a miserable time relates to, I strongly suspect, his prostate gland, rather than his bladder.

As men age, the prostate gland enlarges and, because of the arrangement of the anatomy, this interferes with normal bladder function.

This doughnut-shaped gland sits under the bladder, with the urethra — the tube that takes urine from the bladder to outside the body — passing directly through the middle of it.

Embarrassing problem: A reader's husband needs to go to the loo a lot - sometimes several times an hour (file photo)

Embarrassing problem: A reader's husband needs to go to the loo a lot – sometimes several times an hour (file photo)

In many, if not most, men the gland slowly enlarges as the years go by, and this distorts the base of the bladder slightly and narrows the urethra.

This has a number of consequences, including a tendency to get up more than once at night to empty the bladder, a poor stream when the man does go and feelings of urgency — the need to rush to go — and increased frequency.

This enlargement causes a condition called retention with overflow, and it is this that I believe is affecting your husband.

This is a debilitating condition, and is caused by months or years of gradual near obstruction of the prostate, eventually causing him to urinate frequently, but never completely.

An ultrasound scan will show how much remains in the bladder after he believes he has emptied it — it may be a considerable volume, even a pint or two.

The issue with retention is that it can lead to occasional infection, due to residual urine irritating the bladder lining, and it seems that your husband has experienced this.

However I do not believe that the diabetes is relevant, though it may well make infection more likely, because the high sugar levels in the urine of diabetics make it a fertile breeding ground for bacteria.

Another, more severe, side effect, which can occur if your husband’s condition is not properly treated, is complete retention of urine.

This occurs when the urethra has become so narrowed that passing anything at all becomes impossible. The only solution is an urgent trip to hospital for catheterisation.

Another reader has been diagnosed with a dietary sensitivity to indole acetic acid, following years of uncomfortable gut sensations and hot flushes (file photo)

Another reader has been diagnosed with a dietary sensitivity to indole acetic acid, following years of uncomfortable gut sensations and hot flushes (file photo)

This is a way of emptying the bladder by introducing a catheter, a fine rubber tube, along the urethra, using a local anaesthetic gel. The bladder is instantly drained, and it buys time for the urologist to make plans to relieve the obstruction permanently, usually by an operation.

Your husband should be seen by a urologist, who will arrange an ultrasound scan — before and after urination — and uro-flowmetry, when (in private) he will pass water through a measuring system.

These will show how his bladder is performing, and assist the specialist in reaching the correct diagnosis. If I am right, there is much that can be done to help relieve your husband, though there is a high probability that he will need an operation.

Having experienced uncomfortable gut
sensations and hot flushes for many years, I have been diagnosed with a
dietary sensitivity to indole acetic acid. The biochemist gave me a list
of foods to avoid, mostly fruit, vinegar and alcohol. Do you have any
more advice I am 74.
Mrs A. Rigg, Penrith, Cumbria.

There seems to have been an error of
communication here, for I have never come across the complaint you
describe: a dietary sensitivity to indole acetic acid, also known as
5HIAA.

This compound is produced by chemical
reactions in the body and can also be found in foods such as avocados,
bananas, aubergines, pineapples, plums and walnuts.

I have discussed your letter in detail
with a dietician friend, and neither of us have seen a clinical
syndrome in which patients experience symptoms from eating those foods.
However, there is a disease in which the chemical is produced in excess
in the body, giving rise to symptoms that include bouts of flushing,
sweating, intestinal cramps and diarrhoea — with spectacular abdominal
rumbles (borborygmi) as a feature.

CONTACT DR SCURR

To contact Dr Scurr with a health query, write to him at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] – including contact details.

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

Always consult your own GP with any health worries.

This disease is caused by a problem
with the neuroendocrine system, a network of glands that controls the
release of hormones in the body. One possibility is a growth, which
forms over a number of years, and these usually originate in the
intestine, often the appendix.

If the condition is suspected, the
diagnosis may be established by a 24-hour urine collection, which is
examined for indole acetic acid and related chemicals.

When undertaking the urine collection,
the patient is advised to avoid those foods that contain the chemical —
otherwise it could affect the test results. If, despite restriction of
those foods, high levels are found in the urine then a search for the
problem can be undertaken by CT scanning or a similar technique.

I believe you have been undergoing the
correct investigations to evaluate the possibility of a problem with
your neuroendocrine system, and there may have been an abnormal result,
leading to the advice you should avoid those foods for at least three
days before undergoing another 24-hour urine collection to re-check your
levels.

At this point, I suggest that you do
not yet have an exact diagnosis. As I so often say, good communication
is everything — somebody needs to be holding your hand carefully through
this process.

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Read carefully: Ninety per cent of all the medical ills that might befall you are not covered by private health insurance

How can this kind of decision be entrusted to the administration department of an insurance company — which is a profit- making business

The fact is that a GP knows what’s best for a given problem in a patient for whom he is caring, not an anonymous clerk.

Recently, I referred a patient with a significant knee problem to a leading specialist at a dedicated knee surgery unit. The patient is a championship-level skier, and the specialist is doubly qualified: as an orthopaedic surgeon with a particular interest in the knee and as a sports injury consultant.

However, the insurer informed the patient that the specialist ‘is not registered’ — by which the clerk meant he charges a fee that is outside of their preferred fee schedule.

And so the patient was recommended to take himself to another orthopaedic consultant. I’d not heard of this second consultant, but presumably he would give an opinion and maybe operate for the fee the insurer wishes to pay.

My suspicion is that the insurance company has fixed itself up with a list of consultants who have agreed to work (maybe because they need the referrals) at bargain prices.

Furthermore, how can we be sure they won’t push the patients through double-quick — pile ’em high and do it cheap — when the whole point in going privately is to get that bit more time and care

And if the insurance company is setting the fee, what does the Competition Commission make of it

So my advice is beware. There are plenty of insurance companies. Read the smallprint, take good advice and tread warily when entering the world of private medicine.